Nonalcoholic steatohepatitis (NASH) is rapidly becoming the leading indication for liver transplantation in the US. However, patients with NASH face significant barriers to care, including challenges related to weight loss, which is often required for liver transplant eligibility. Unlike patients with alcohol-associated liver disease (ALD), who have access to multiple resources to promote sobriety, individuals with NASH lack validated, affordable weight loss programs. While weight loss is not a predictor of better post-transplant survival, it can exacerbate sarcopenia, a condition linked to poor outcomes. This highlights that weight loss should not be used as a requirement for liver transplant eligibility in patients with NASH.

Patients with NASH face higher waitlist mortality than those with ALD, despite similar post-transplant survival rates. Weight loss requirements for patients with NASH are misguided and may actually worsen outcomes by contributing to sarcopenia. Data show that patients with higher pretransplant BMI benefit more from transplantation, contradicting the belief that weight loss improves survival. Weight loss after transplant has been shown to have more benefits, and patients with NASH do not face a higher risk of graft loss compared to patients with ALD. As NASH becomes the leading cause for liver transplant, it is essential to prioritize patients with NASH and remove weight loss as a prerequisite for transplant eligibility, ensuring equity in access to care.

Reference: Manfready RA, Rzepczynski A, Janardhan SV. Which patient should be prioritized for liver transplant: NAFLD? Clin Liver Dis (Hoboken). 2024 Jun 7;23(1):e0163. doi: 10.1097/CLD.0000000000000163. PMID: 38860126; PMCID: PMC11164004.